The Surgical Treatment Of Coarctation Of The Aorta

Objective : To sum up the experiences of surgical treatment forcoarctation of aorta(CoA) in 7 patients.Method:Analyzing retrospectively the clinic data,surgicaltreatment and efficacy of 7 patients who underwent correctiveoperation for coarctation of aorta in our hospital from May,2000 toDecember,2005.Clinic data:The whole group involve 7 patients,including 5 maleand 2 female. Their ages ranged from 5y to 36y,and the mean age is13.8±11.8y.The weight ranged from 18-77Kg(mean 3.56 ± 0.76Kg).The presenting symptoms of the patients are dyspnea andfatigue after action.The blood pressure of upper extremity washigher than lower extremity apparently.The systolic blood pressuregradient ranged from 40 to 87mmHg with a mean gradient of 64.0±15.2mmHg.5 patients had a systolic heart murmur at left sternalborder and 2 patients had a systolic heart murmur at back,and 3patients had systolic hypertension before operation. All patients hadbeen diagnosed as CoA through X-ray, electrocardiogram andechocardiographic examination.3 patients diagnosed as CoA withMRI and 2 patients with Cardiac catheterization .The coarctationwere all after ductus arteriosus or ductus ligament.The length of thecoarctation ranged from 0.9-3.0 cm,and the inner diameter of aortaranged from 0.4-0.9 cm。Among 7 cases,there was 1 case diagnosedas CoA with patent ductus arteriosus(PDA) and 1 case diagnosedas CoA with ventricular septal defect(VSD),2 with PDA andventricular septal defect(VSD).Indications:Hypertension of the upper limb,the difference ofthe systolic pressure between the upper limb and the lower limb ishigher than 50 mmHg or the diameter of the aortal lumen'sstegnosis distracts larger than 50%.They are all indications foroperations.We should operate as soon as possible in the followingconditions ,such as serious hypertension of pulmonary artery ininfant stage,congestive heart failure or deformity of inner cardialstructure which is badly in need of operation. Operations on the childwhose cardial function is still compensatory may be put off until thechild is 4-6 years old.Surgical techniques: For isolated CoA patients,the fourth leftposterior lateral intercostal thoracotomy was used,and then separatedcarefully around the CoA and resection port of aortic coarctation.In 1case,which had been diagnosed as CoA with patent ductusarteriosus (PDA),through left posterior lateral intercostalthoracotomy, the PDA was cut and sutured first,and then separatedcarefully around the CoA and resection port of aortic coarctation. 1patient required a two-stage repair for his CoA and associated VSD.At first,through left posterior lateral intercostal thoracotomy, theCoA was separated carefully and resected.After 8 days,theintracardiac anomalies was corrected via median sternotomyon-pump. In 2 cases,which had been diagnosed as CoA with PDAand VSD preoperatively, the PDA were cutand sutured,and thenseparated carefully around the CoA and resection port of aorticcoarctation through left posterior thoracotomy. Immediately afterthis,the ventricular septal defect were corrected via mediansternotomy on-pump. The types of surgical procedures mainlyincluded resection and direct end-to-end anastomosis, and syntheticpatch aortoplasty.Results: The moving time of exbracorporeal circulation is 20-30min(mean 23.0士4.7min)。The blood pressure of lower extremitywas higher than upper extremity in 5 cases after operation.There isno stage diversity of pressure for lower and upper extremity in 2cases after operation. There was no paraplegia, kidney failure.Long-term follow-up was available in all survivors. No patientdied,and no patients had the recurrent obstruction throughechocardiographic examination.Only 1 adult patient had systemichypertension.Conclusions: 1,Operations on the child whose cardial functionis still compensatory may be put off until the child is 4-6 years old.2,The type of surgical procedure mainly depend on the experienceof the surgeon and the coarctation . The length of the coarctation lessthan 1.5cm ,resection and direct end-to-end anastomosis can bechosen;the length of the coarctation more than 1.5cm , syntheticpatch aortoplasty should be chosen.3,It is a better way to correct thecoarctation of aorta associated with intracardiacanomalies atone-stage. Double-incision is safe and effective.